Trans-catheter aortic valve implantation without contrast using the Lotus mechanically-expanded heart valve

We report a case of a TAVI in an 80-year-old patient with severe AS and significant chronic kidney disease (CKD), which was carried out without the use of contrast and with minimal procedural hypotension.Pre-procedural imaging was carried out using 3D trans-esophageal echocardiography (TEE) rather than computed tomography (CT) to avoid contrast administration. The Lotus valve (Boston Scientific, Marlborough, MA, USA) was chosen due to a number of design features which minimize both the need for contrast injection and procedural hypotension during valve positioning and deployment. The procedure was carried out successfully and produced an excellent result with no decline in renal function. We believe that the approach of using TEE and the mechanically-expanded Lotus valve illustrates an important therapeutic approach in patients with severe CKD.<Learning objective: Post-procedural acute kidney injury (AKI) is a frequent complication following trans-catheter aortic valve implantation (TAVI), and is associated with increased mortality. The principal procedural issues are contrast-induced nephropathy and intra-procedural hypotension. Our case report demonstrates how TAVI can be performed with zero contrast and minimization of procedural hypotension, facilitated by the use of trans-esophageal echocardiography and the mechanically-expanded Lotus valve. This approach should only be used in exceptional circumstances, but can be particularly relevant for patients with pre-existing...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research